Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, USA; Graduate School for Health Sciences, University of Bern, Switzerland; Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Switzerland.
Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, USA.
J Stroke Cerebrovasc Dis. 2024 Dec;33(12):108045. doi: 10.1016/j.jstrokecerebrovasdis.2024.108045. Epub 2024 Sep 28.
Cancer is associated with an increased risk of atrial fibrillation. Whether cancer is also associated with atrial cardiopathy, another atrial pathology associated with heightened ischemic stroke risk, is uncertain.
We conducted a retrospective cross-sectional study among consecutive patients hospitalized with acute ischemic stroke at a quaternary care center in New York, United States from 2011 through 2016. The study exposure was active cancer. The study outcome was atrial cardiopathy, defined as a left atrial volume index ≥35 mL/m on echocardiography. We used multivariable logistic regression, adjusting for baseline characteristics, to evaluate the relationship between cancer (active or historical) and atrial cardiopathy. We performed a subgroup analysis among patients with embolic stroke of undetermined source (ESUS).
The final cohort included 1104 patients with acute ischemic stroke, of whom 10 % had active cancer and 47 % had atrial cardiopathy. Patients with atrial cardiopathy, compared to those without, were older (median age, 77 versus 68 years), and more frequently had hypertension, coronary disease, and atrial fibrillation. Active cancer was present in 9.6 % of patients with atrial cardiopathy (n = 50/520) and 10.4 % of patients without (n = 61/584). There was no association between active cancer and atrial cardiopathy among the overall ischemic stroke cohort (adjusted odds ratio [OR], 0.91; 95 % confidence interval [CI], 0.60-1.37) nor in patients with ESUS (aOR, 0.64; 95 % CI, 0.30-1.36). When the cancer exposure was broadened to include any history of cancer (n = 236, 21.4 %), there still was no significant association with atrial cardiopathy (aOR, 0.93; 95 % CI, 0.68-1.25).
When defining atrial cardiopathy by left atrial volume, we did not find an association between cancer and atrial cardiopathy in patients with ischemic stroke, including among those with ESUS. Future studies, evaluating other atrial cardiopathy biomarkers and settings, are needed to further investigate any potential link between cancer and atrial cardiopathy.
癌症与心房颤动的风险增加有关。然而，癌症是否也与心房心肌病有关，后者是另一种与缺血性卒中风险升高相关的心房病理，目前尚不确定。
我们在美国纽约的一家四级医疗中心进行了一项回顾性的横断面研究，该研究纳入了 2011 年至 2016 年期间因急性缺血性卒中住院的连续患者。研究的暴露因素是活动性癌症。研究结局为心房心肌病，定义为经超声心动图检查左心房容积指数≥35ml/m2。我们使用多变量逻辑回归，调整基线特征，来评估癌症（活动性或既往性）与心房心肌病之间的关系。我们在不明来源栓塞性卒中（ESUS）患者中进行了亚组分析。
最终的队列包括 1104 例急性缺血性卒中患者，其中 10%为活动性癌症，47%患有心房心肌病。与无心房心肌病的患者相比，患有心房心肌病的患者年龄更大（中位数年龄 77 岁比 68 岁），且更常患有高血压、冠心病和心房颤动。520 例（9.6%）患有心房心肌病的患者中存在活动性癌症（n=50），584 例（10.4%）无心房心肌病的患者中存在活动性癌症（n=61）。在整个缺血性卒中队列中，活动性癌症与心房心肌病之间没有关联（调整后的优势比 [OR]，0.91；95%置信区间 [CI]，0.60-1.37），在 ESUS 患者中也没有关联（OR，0.64；95%CI，0.30-1.36）。当将癌症暴露范围扩大到包括任何既往癌症史（n=236，21.4%）时，与心房心肌病仍无显著关联（OR，0.93；95%CI，0.68-1.25）。
当通过左心房容积定义心房心肌病时，我们并未发现缺血性卒中患者中癌症与心房心肌病之间存在关联，包括 ESUS 患者。需要进一步研究其他心房心肌病生物标志物和环境，以进一步探讨癌症与心房心肌病之间的潜在联系。
